Lung recruitment in mechanical ventilation

Abstract

A ventilation system includes a breathing apparatus which provides a mechanical ventilation to a patient. The breathing apparatus is configured to perform an automated full recruitment manoeuvre, FRM, comprising a recruitment phase and a PEEP titration phase, wherein the PEEP titration phase is a phase of stepwise decrease in PEEP from a maximum PEEP level to a minimum PEEP level, via one or more intermediate PEEP levels. The breathing apparatus is configured to deliver a number of breaths at each PEEP level, and to monitor a parameter indicative of a potentially harmful level of ventilation during the PEEP titration. The breathing apparatus is further configured to automatically decrease PEEP to a lower PEEP level when the monitored parameter reaches a first threshold value.

The invention claimed is: 
     
       1. A ventilation system, comprising:
 a breathing apparatus providing a mechanical ventilation to a patient, the breathing apparatus being configured to perform an automated full recruitment manoeuvre, FRM, comprising a recruitment phase and a PEEP titration phase, wherein the PEEP titration phase is a phase of stepwise decrease in PEEP from a maximum PEEP level to a minimum PEEP level, via one or more intermediate PEEP levels, the breathing apparatus being configured to deliver a number of breaths at each PEEP level, and to monitor a parameter indicative of a potentially harmful level of ventilation during the PEEP titration, the breathing apparatus further being configured to automatically decrease PEEP to a lower PEEP level when the monitored parameter reaches a first threshold value. 
 
     
     
       2. The ventilation system of  claim 1 , wherein the breathing apparatus is configured to decrease PEEP to a lower PEEP level only when the monitored parameter reaches the first threshold value at least for a second time on a current PEEP level. 
     
     
       3. The ventilation system of  claim 1 , wherein the breathing apparatus is configured to decrease PEEP to a lower PEEP level when the monitored parameter reaches the first threshold value for a first time on a current PEEP level only if the monitored parameter has reached the first threshold value during ventilation on any of the preceding PEEP levels. 
     
     
       4. The ventilation system of  claim 3 , wherein the breathing apparatus is configured to decrease PEEP to a lower PEEP level when the monitored parameter reaches the first threshold value for at least a second time on a current PEEP level even if the monitored parameter has not reached the first threshold value during ventilation on any of the preceding PEEP levels. 
     
     
       5. The ventilation system of  claim 1 , wherein the breathing apparatus is configured to determine if the monitored parameter reaches a second threshold value being lower than the first threshold value during at least two consecutive breaths, and to decrease PEEP to a lower PEEP level if the monitored parameter reaches the second threshold value during at least two consecutive breaths. 
     
     
       6. The ventilation system of  claim 1 , wherein the monitored parameter is indicative of a respiratory pressure of the patient. 
     
     
       7. A method for lung recruitment in a patient being mechanically ventilated by a breathing apparatus, comprising the steps of:
 performing an FRM manoeuvre comprising a recruitment phase and a PEEP titration phase, wherein the PEEP titration phase is a phase of stepwise decrease in PEEP from a maximum PEEP level to a minimum PEEP level, via one or more intermediate PEEP levels; 
 delivering a number of breaths at each PEEP level; 
 monitoring a parameter indicative of a potentially harmful level of ventilation during the PEEP titration; and 
 automatically decreasing PEEP to a lower PEEP level based on a determination that the monitored parameter has reached a first threshold value. 
 
     
     
       8. The method of  claim 7 , wherein the determination that the monitored parameter has reached the first threshold value includes determining that the monitored parameter has reached the first threshold value at least for a second time on a current PEEP level. 
     
     
       9. The method of  claim 7 , wherein the determination that the monitored parameter has reached the first threshold value includes determining that the monitored parameter has reached the first threshold value for a first time on a current PEEP level only if the monitored parameter has reached the first threshold value during ventilation on any of the preceding PEEP levels. 
     
     
       10. The method of  claim 9 , wherein the determination that the monitored parameter has reached the first threshold value includes determining that the monitored parameter has reached the first threshold value for at least a second time on a current PEEP level even if the monitored parameter has not reached the first threshold value during ventilation on any of the preceding PEEP levels. 
     
     
       11. The method of  claim 7 , further comprising a steps of:
 determining that the monitored parameter has reached a second threshold value being lower than the first threshold value during at least two consecutive breaths, and decreasing PEEP to a lower PEEP level based on the determination that the monitored parameter has reached the second threshold value during at least two consecutive breaths. 
 
     
     
       12. The method of  claim 7 , wherein the monitored parameter is indicative of a respiratory pressure of the patient. 
     
     
       13. A computer program product comprising a non-volatile memory storing a computer program for lung recruitment in a mechanically ventilated patient, the computer program comprises computer-readable instruction which, when executed by a computer of a ventilation system comprising a breathing apparatus, causes the ventilation system to perform operations, comprising:
 performing an FRM manoeuvre comprising a recruitment phase and a PEEP titration phase, wherein the PEEP titration phase is a phase of stepwise decrease in PEEP from a maximum PEEP level to a minimum PEEP level, via one or more intermediate PEEP levels; 
 deliver a number of breaths at each PEEP level; 
 monitoring a parameter indicative of a potentially harmful level of ventilation during the PEEP titration; and 
 automatically decreasing PEEP to a lower PEEP level based on a determination that the monitored parameter has reached a first threshold value.